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Yu Z, Chan S, Wang X, Sun R, Wang M, Wang Z, Zuo X, Chen J, Zhang H, Chen W. 5-Fluorouracil Combined with Rutaecarpine Synergistically Suppresses the Growth of Colon Cancer Cells by Inhibiting STAT3. Drug Des Devel Ther 2023; 17:993-1006. [PMID: 37020802 PMCID: PMC10069641 DOI: 10.2147/dddt.s402824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose To evaluate the effect of 5-fluorouracil (5-FU) combined with rutaecarpine (RUT) on the antiproliferative, anti-migratory, and apoptosis-promoting ability of colorectal cancer (CRC) cells and explore the underlying mechanism. Methods The antiproliferative effects of RUT and 5-FU on CRC cells were evaluated using MTT and colony formation assays. Anti-migration was assessed by cell scratch and transwell tests. The synergistic effect of RUT and 5-FU was assessed by isobologram and combination index analysis using CompuSyn software. The effects of RUT and 5-FU on cell apoptosis were detected by flow cytometry. Differences in protein expression levels with or without RUT and/or 5-FU treatment were assessed by Western blot. Moreover, a mouse xenograft model of CRC was established to investigate the antitumor effect of RUT and 5-FU in vivo, and Ki67 and cleaved caspase-3 expression was detected by immunofluorescence. Results In this study, we found that 5-FU combined with RUT can inhibit the proliferative, migratory, and antiapoptotic abilities of CRC cells to a significantly greater extent than either RUT or 5-FU alone both in vivo and in vitro. Western blot analysis showed that the level of signal transducer and activator of transcription 3 (STAT3) phosphorylation in CRC cells was significantly reduced after combination therapy compared with that seen with the respective monotherapies. In addition, combination therapy influenced the STAT3 signaling pathway, namely, it inhibited the expression of c-Myc, CDK4, and Bcl-2 while enhancing that of the proapoptotic protein cleaved caspase-3. Immunofluorescence staining further showed that the expression of Ki67 and cleaved caspase-3 was significantly downregulated and upregulated, respectively, in tumor tissues of mice treated with combination therapy compared with that observed with 5-FU treatment alone. Conclusion Combined therapy with 5-FU and RUT exerted a superior curative effect in CRC than treatment with either single drug alone and has potential as a novel therapeutic modality for the treatment of CRC.
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Affiliation(s)
- Zhen Yu
- Department of General Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China
| | - Shixin Chan
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China
| | - Xu Wang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China
| | - Rui Sun
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China
| | - Ming Wang
- Department of General Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China
| | - Zhenglin Wang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China
| | - Xiaomin Zuo
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China
| | - Jiajie Chen
- Department of Dermatology, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China
| | - Huabing Zhang
- Department of Biochemistry & Molecular Biology, School of Basic Medicine, Anhui Medical University, Hefei, 230032, People’s Republic of China
| | - Wei Chen
- Department of General Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China
- Anhui Provincial Institute of Translational Medicine, Hefei, 230022, People’s Republic of China
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Patra A, Baheti AD, Ankathi SK, Desouza A, Engineer R, Ostwal V, Ramaswamy A, Saklani A. Can Post-Treatment MRI Features Predict Pathological Circumferential Resection Margin (pCRM) Involvement in Low Rectal Tumors. Indian J Surg Oncol 2020; 11:720-725. [PMID: 33281411 DOI: 10.1007/s13193-020-01218-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022] Open
Abstract
The MERCURY II study demonstrated the use of MRI-based risk factors such as extramural venous invasion (EMVI), tumor location, and circumferential resection margin (CRM) involvement to preoperatively predict pCRM (pathological CRM) outcomes for lower rectal tumors in a mixed group of upfront operated patients and patients who received neoadjuvant treatment. We aim to study the applicability of results of MERCURY II study in a homogeneous cohort of patients who received neoadjuvant chemoradiation (NACTRT) prior to surgery. After Institutional Review Board approval, post NACTRT restaging MRI of 132 patients operated for low rectal cancer between 2014 and 2018 were retrospectively reviewed by two radiologists for site of tumor, EMVI status, distance from anal verge (< 4 or > 4 cm), and mrCRM positivity. Findings were compared with post surgery pCRM outcomes using Fisher's exact test. Only 9/132(7%) patients showed pCRM involvement on histopathology, 8 of them being CRM positive on MRI (p = 0.01). The positive predictive value (PPV) of mrCRM positive status and pCRM status was 12.7% (95% CI: 9.7-16.5%), while the negative predictive value was 98.5% (95% CI: 91.4-99.8%) (p = 0.01). EMVI positive and anteriorly located tumors showed higher incidence of pCRM positivity but were not found to be significant (15% vs 5.2% and p = 0.13 and 8.6% vs 2.1% and p = 0.28, respectively). Unsafe mrCRM was the only factor significantly associated with pCRM positivity on post neoadjuvant restaging MRI. Tumors less than 4 cm from anal verge, anterior tumor location, and mrEMVI positivity did not show statistically significant results to predict pCRM involvement.
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Affiliation(s)
- A Patra
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India.,Department of Radiodiagnosis, Homi Bhabha National Institute, Mumbai, India
| | - A D Baheti
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India.,Department of Radiodiagnosis, Homi Bhabha National Institute, Mumbai, India
| | - S K Ankathi
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India.,Department of Radiodiagnosis, Homi Bhabha National Institute, Mumbai, India
| | - A Desouza
- Department of Radiodiagnosis, Homi Bhabha National Institute, Mumbai, India.,Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - R Engineer
- Department of Radiodiagnosis, Homi Bhabha National Institute, Mumbai, India.,Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - V Ostwal
- Department of Radiodiagnosis, Homi Bhabha National Institute, Mumbai, India.,Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Ramaswamy
- Department of Radiodiagnosis, Homi Bhabha National Institute, Mumbai, India.,Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Saklani
- Department of Radiodiagnosis, Homi Bhabha National Institute, Mumbai, India.,Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
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Butiurca VO, Molnar C, Constantin C, Botoncea M, Bud TI, Kovacs Z, Satala C, Gurzu S. Long Term Results of Modified Intersphincteric Resections for Low Rectal Cancer: A Single Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:medicina55120764. [PMID: 31795439 PMCID: PMC6955682 DOI: 10.3390/medicina55120764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The objective of this article is to evaluate the long-term oncological and functional outcomes following modified intersphincteric resections (ISR) for low rectal cancer. The modified technique consisted of the abandonment of colonic J-pouches, transverse coloplasty, or defunctioning temporary stoma in favor of a direct handsewn coloanal anastomosis (CAA). MATERIAL AND METHODS Sixty consecutive patients with type II and III (juxta-anal or intra-anal) low rectal tumors underwent modified ISR by the same surgical team and were followed for a period of five years. Functional outcomes using the Wexner Score, postoperative complications, recurrence rates, morbidity, and mortality rates were assessed. RESULTS The five-year survival rate was 93.3% with a disease-free interval at three years of 98%. Morbidity was 15% (n = 9) consisting of intestinal wall necrosis (n = 6), stenosis (n = 2), and sacral metastasis (n = 1). The Wexner score values were, at 1 year, 8.5 (range, 4-13); at three years 7.2 (range, 2-11); and at 5 years 6.7 (range, 2-12). A second surgery was needed in only one case that showed postoperative transmural necrosis of the colonic wall. CONCLUSIONS In highly selected patients with type II or III low rectal tumors and proper preoperative imaging staging, ISR might be a viable alternative to other techniques such as abdominoperineal resection and low anterior resection, both from a functional and an oncological perspective.
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Affiliation(s)
- Vlad-Olimpiu Butiurca
- First Department of Surgery, University of Medicine, Pharmacy, Science and Technology ‘George Emil Palade’, 540139 Târgu-Mureș, Romania; (V.-O.B.); (C.C.); (M.B.)
- Clinic of Vascular Surgery, Emergency County Hospital, 540139 Târgu-Mureș, Romania;
| | - Călin Molnar
- First Department of Surgery, University of Medicine, Pharmacy, Science and Technology ‘George Emil Palade’, 540139 Târgu-Mureș, Romania; (V.-O.B.); (C.C.); (M.B.)
- Correspondence: ; Tel.: +40-07-2224-1281
| | - Copotoiu Constantin
- First Department of Surgery, University of Medicine, Pharmacy, Science and Technology ‘George Emil Palade’, 540139 Târgu-Mureș, Romania; (V.-O.B.); (C.C.); (M.B.)
| | - Marian Botoncea
- First Department of Surgery, University of Medicine, Pharmacy, Science and Technology ‘George Emil Palade’, 540139 Târgu-Mureș, Romania; (V.-O.B.); (C.C.); (M.B.)
| | - Teodor Ioan Bud
- Clinic of Vascular Surgery, Emergency County Hospital, 540139 Târgu-Mureș, Romania;
| | - Zsolt Kovacs
- Department of Pathology, Emergency County Hospital, 540136 Târgu-Mureș, Romania; (Z.K.); (C.S.)
| | - Cătălin Satala
- Department of Pathology, Emergency County Hospital, 540136 Târgu-Mureș, Romania; (Z.K.); (C.S.)
| | - Simona Gurzu
- Department of Pathology, University of Medicine, Pharmacy, Science and Technology, 540139 Târgu-Mureș, Romania;
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Fusco R, Granata V, Rega D, Russo C, Pace U, Pecori B, Tatangelo F, Botti G, Izzo F, Cascella M, Avallone A, Delrio P, Petrillo A. Morphological and functional features prognostic factor of magnetic resonance imaging in locally advanced rectal cancer. Acta Radiol 2019; 60:815-825. [PMID: 30286607 DOI: 10.1177/0284185118803783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Roberta Fusco
- Division of Radiology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale,” Naples, Italy
| | - Vincenza Granata
- Division of Radiology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale,” Naples, Italy
| | - Daniela Rega
- Division of Gastrointestinal Surgical Oncology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale,” Naples, Italy
| | - Carolina Russo
- Division of Radiology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale,” Naples, Italy
| | - Ugo Pace
- Division of Gastrointestinal Surgical Oncology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale,” Naples, Italy
| | - Biagio Pecori
- Divion of Radiotherapy, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale,” Naples, Italy
| | - Fabiana Tatangelo
- Division of Diagnostic Pathology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale,” Naples, Italy
| | - Gerardo Botti
- Division of Diagnostic Pathology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale,” Naples, Italy
| | - Francesco Izzo
- Division of Hepatobiliary Surgical Oncology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale,” Naples, Italy
| | - Marco Cascella
- Division of Anesthesia, Endoscopy and Cardiology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale,” Naples, Italy
| | - Antonio Avallone
- Division of Gastrointestinal Medical Oncology, “Istituto Nazionale Tumori Fondazione Giovanni Pascale – IRCCS,” Naples, Italy
| | - Paolo Delrio
- Division of Gastrointestinal Surgical Oncology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale,” Naples, Italy
| | - Antonella Petrillo
- Division of Radiology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale,” Naples, Italy
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Armbruster M, D'Anastasi M, Holzner V, Kreis ME, Dietrich O, Brandlhuber B, Graser A, Brandlhuber M. Improved detection of a tumorous involvement of the mesorectal fascia and locoregional lymph nodes in locally advanced rectal cancer using DCE-MRI. Int J Colorectal Dis 2018; 33:901-909. [PMID: 29774398 DOI: 10.1007/s00384-018-3083-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE The prediction of an infiltration of the mesorectal fascia (MRF) and malignant lymph nodes is essential for treatment planning and prognosis of patients with rectal cancer. The aim of this study was to assess the additional diagnostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the detection of a malignant involvement of the MRF and of mesorectal lymph nodes in patients with locally advanced rectal cancer. METHODS In this prospective study, 22 patients with locally advanced rectal cancer were examined with 1.5-T MRI between September 2012 and April 2015. Histopathological assessment of tumor size, tumor infiltration to the MRF, and malignant involvement of locoregional lymph nodes served as standard of reference. Sensitivity and specificity of detecting MRF infiltration and malignant nodes (nodal cut-off size [NCO] ≥ 5 and ≥ 10 mm, respectively) was determined by conventional MRI (cMRI; precontrast and postcontrast T1-weighted, T2-weighted, and diffusion-weighted images) and by additional semi-quantitative DCE-MRI maps (cMRI+DCE-MRI). RESULTS Compared to cMRI, additional semi-quantitative DCE-MRI maps significantly increased sensitivity (86 vs. 71% [NCO ≥ 5 mm]/29% [NCO ≥ 10 mm]) and specificity (90 vs. 70% [NCO ≥ 5 mm]) of detecting malignant lymph nodes (p < 0.05). Moreover, DCE-MRI significantly augmented specificity (91 vs. 82%) of discovering a MRF infiltration (p < 0.05), while there was no change in sensitivity (83%; p > 0.05). CONCLUSION DCE-MRI considerably increases both sensitivity and specificity for the detection of small mesorectal lymph node metastases (≥ 5 mm but < 10 mm) and sufficiently improves specificity of a suspected MRF infiltration in patients with locally advanced rectal cancer.
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Affiliation(s)
- Marco Armbruster
- Clinic of Radiology, Ludwig Maximilians University of Munich, Marchionini Str. 15, 81377, Munich, Germany
| | - Melvin D'Anastasi
- Medical Imaging Department, Mater Dei Hospital, Tal-Qroqq, Msida, MSD 2090, Malta
| | - Veronika Holzner
- Kinderkrankenhaus St.Marien Landshut, Grillparzerstraße 9, 84036, Landshut, Germany
| | - Martin E Kreis
- Department of General-, Visceral- and Vascular Surgery, Charité University Medicine Berlin, Campus Benjamin Franklin Hindenburgdamm 30, 12200, Berlin, Germany
| | - Olaf Dietrich
- Clinic of Radiology, Ludwig Maximilians University of Munich, Marchionini Str. 15, 81377, Munich, Germany
| | - Bernhard Brandlhuber
- Department of Internal Medicine, Klinik Mühldorf am Inn, Krankenhausstraße 1, 84453, Mühldorf am Inn, Germany
| | - Anno Graser
- Gemeinschaftspraxis Radiologie München, Burgstraße 7, 80331, Munich, Germany
| | - Martina Brandlhuber
- Clinic of Radiology, Ludwig Maximilians University of Munich, Marchionini Str. 15, 81377, Munich, Germany.
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